H O S T E D BY Available online at www.sciencedirect.

com

ScienceDirect
Journal of Sport and Health Science 5 (2016) 151–154
www.jshs.org.cn

Review
The role of physical activity and exercise in obesity and weight
management: Time for critical appraisal
Petri Wiklund *
Department of Health Sciences, University of Jyväskylä, Jyväskylä FI-40014, Finland
Received 15 January 2016; revised 1 March 2016; accepted 21 March 2016
Available online 8 April 2016

Abstract
The prevalence of overweight and obesity has increased dramatically during last 3 decades with devastating consequences to public health.
Recommended strategies to reduce obesity have focused on healthier diet and physical activity (PA). Clearly, these approaches have not been
successful, but whether this is due to failure to restrict energy intake or to maintain high levels of energy expenditure has been the subject of great
controversy. Consequently, there has been a great deal of confusion about the role of PA and exercise in obesity and weight management. In this
article, the theoretical basis for considering reduced PA and energy expenditure as the cause of obesity is appraised. Further, the role of PA in food
intake and weight control is examined. The idea that obesity is caused by consistent decline in daily energy expenditure is not supported either by
objective measures of energy expenditure or physiological theory of weight gain alone. However, since voluntary exercise is the most important
discretionary component of total daily energy expenditure, it can affect energy balance. Therefore, PA and exercise hold potential as part of the
solution for the ongoing obesity epidemic.
© 2016 Production and hosting by Elsevier B.V. on behalf of Shanghai University of Sport. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords: Energy expenditure; Exercise; Obesity; Overweight; Physical activity

1. Introduction these 2 elements has been the subject of sparking debate.5–7

The prevalence of overweight and obesity has increased
substantially in all societies across the globe during last 3
decades (Fig. 1), and all indications are that this trend is likely
to continue unabated in the coming years.1 This is a major
public health concern because obesity has far reaching negative
effects on health. The risk of type 2 diabetes, cardiovascular
disease, certain types of cancers, and even mortality are
directly proportional to the degree of obesity.2,3 Thus, it goes
without saying that there is a need to reverse this modern
epidemic. Public health actions to reduce obesity have mostly
focused on individuals, encouraging them to eat healthier and
to exercise more. But so far, these approaches are failing as not
a single country has succeeded in reducing obesity rates in the
past 30 years.4 Whether this is due to failure to restrict energy
intake or to maintain high levels of energy expenditure has yet
to be determined conclusively, and the relative importance of
Peer review under responsibility of Shanghai University of Sport.
* E-mail address: petri.wiklund@jyu.fi
http://dx.doi.org/10.1016/j.jshs.2016.04.001
2095-2546/© 2016 Production and hosting by Elsevier B.V. on behalf of Shanghai University of Sport. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
The lack of consensus has led to a great deal of confusion of
the usefulness of physical activity (PA) in weight loss, and the
media’s messages about the futility of exercise have nothing
but galvanized this perplexity. In this article, I will consider the
role of PA in obesity development and its usefulness in weight
management.
2. Secular trends in occupational and household-related
PA appear to be congruent with the dynamics of the
population weight gain
Conceptually, obesity is a condition in which the amount of
body fat exceeds the biological need of an individual. Obesity is
a manifestation of a positive energy balance that has been
sustained over an extended period of time. However, the reason
why this condition has spread inexorably across the globe over
the past 3 decades with such speed is not well understood.
Generally speaking, the human genome has not changed sub-
stantially during this time; therefore, the rise in obesity most
likely reflects changes in the environment and/or behavior.
During the past half-century mechanization has impinged upon
152
Fig. 1. Changes (%) in adult obesity prevalence over time in selected countries
around the world.50 BMI = body mass index. Reproduced with permission of
World Obesity Federation.
our modes of living in diverse ways. Consequently, energy
expenditure required for daily living has continuously declined.
A recent study showed that in the US, daily energy expenditure
due to work related PA has decreased by more than 100 kcal
during last 50 years in both men and women, and this reduction
is associated with the increase in mean body weight during this
time frame.8 Similar trends have also been observed in other
countries including Finland, where daily energy expenditure
during work reportedly decreased by more than 50 kcal
between 1982 and 1992 while the average body weight relent-
lessly crept upward.9 More recent studies indicated that these
trends have continued unabated up to the present day.10,11 Sub-
stantial reductions in daily energy expenditure have also
occurred in developing countries such as China and Brazil,
which have the highest absolute and relative rates of decline in
total PA due to reductions in movement at work.12 For this
reason, it is believed that the obesity epidemic has also pen-
etrated the low-income countries, particularly in the urban
areas, and will continue to spread for the foreseeable future.13
There is also reason to assume that domestic mechanization
of daily tasks (with the advent of labor-saving devices such as
washing machines and dishwashers) have reduced energy
expenditure over the years. Indeed, it was recently estimated
that in women, daily housework-related energy expenditure has
decreased by 360 kcal in the US since the 1960s.14 The authors
of the study concluded that such reductions in housework-
related energy expenditure might have been substantial con-
tributors to the rise in prevalence of obesity in women in last 5
decades. Because such labor-saving devices are habitually used
in all affluent societies, their contribution to population energy
balance in high-income countries has been considered
substantive.15 Domestic mechanization has also contributed to
increased sedentariness, as time spent in house work has been
replaced by sedentary activities such as watching television and
use of other screen based media.16 Many studies have impli-
cated sedentary behavior, including passive transportation, with
weight gain.17–19 On the other hand, participation in leisure-time
physical activity (LTPA) has progressively increased over the
years;20 however, it appears that on a secular basis, this has not
P. Wiklund
been enough to offset increased sedentary behavior, as total PA
is declining rapidly across the globe.12
3. Objective measurements of energy expenditure conflict
the idea that obesity epidemic is attributable to reductions
in daily energy expenditure
Based on the evidence presented above, it seems intuitive
that the rise in bodyweight and obesity is attributable to
decreases in daily energy expenditure. However, on closer scru-
tiny this idea seems highly improbable, and there is fair amount
of evidence to support that contention. First, the “labor-saving”
culture has not changed substantially since the 1960s and
1970s, whereas the obesity prevalence started to increase dra-
matically only around the 1980s. Second, doubly-labeled water
studies (which provide the optimal method to measure energy
expenditure in free-living individuals) show that daily energy
expenditure has not declined between 1980 and 2005 in Europe
or North America.21 Similarly, recent meta-analyses of nearly
100 doubly-labeled water studies indicated that populations in
industrialized countries do not have lower rate of daily energy
expenditure compared with populations in developing
countries.22 Clearly, obese individuals have higher habitual
energy expenditure compared with normal weight people23 (due
to their larger body size and resting metabolic rates). Leibel
et al.24 demonstrated that 10% weight gain increases daily
energy expenditure from 370 to 530 kcal, depending on the
baseline weight. The obvious implication of this is that the rate
of energy intake must also increase accordingly, otherwise
weight loss will ensue.
Consistent with this notion, Swinburn et al.25 examined U.S.
nutritional surveillance data and showed that the estimated
daily energy intake in adults has increased on average by
500 kcal in the US between 1970s and 2000s. Similar findings
have also been reported from several European countries.26,27
However, a more recent examination by Archer et al.28 sug-
gested that once the measures of dietary intake in National
Health and Nutrition Examination Survey (NHANES) were
modified, no substantial difference in energy intake existed.
Energy intake cannot be quantified as precisely as energy
expenditure. The reason why daily energy intake is notably
smaller than simultaneously estimated energy expenditure28,29
may be explained by selective misreporting (over or under) and
recall bias, which are well-known factors that confound studies
investigating energy intake in humans.30 Population energy
intake can also be assessed from the national food availability
data. These data show that daily energy intake in the US
increased slowly until the early 1980s, and then started to
increased rapidly.31 Moreover, a recent global analysis con-
cluded that increases in food-energy supplies are sufficient to
explain increases in average population body weight, particu-
larly in high-income countries.32 Thus, it seems unlikely that
decrements in daily energy expenditure are driving the ongoing
obesity epidemic.
4. The role of PA in food intake and weight control
Decreases in daily energy expenditure may not be the
primary cause of obesity, but that is not to say that PA or
Physical activity and obesity
exercise has no role in weight management and energy balance.
One theory holds that energy balance may be easier to achieve
when energy flux is high. This concept was originally developed
by Mayer et al.33 in the 1950s, and has subsequently been
described by Blundell and King34 and Hill et al.35 According to
this theory, a threshold for PA exists above which people are in
the so called “regulated zone” of energy balance. Those who are
in the regulated zone are able to meet high energy expenditure
needs with energy intake, thus maintaining body weight.
However, those who are below the PA threshold have lower
energy expenditure, and thus are in the “unregulated zone”
without the matching decrements in energy intake. In other
words, this theory suggests that appetite may not be appropri-
ately regulated at low levels of PA. This was recently demon-
strated by Shook et al.;36 they examined the relation between
energy intake, PA, appetite, and weight gain during a 1-year
follow-up, and reported that individuals with low PA had higher
levels of cravings for foods compared with those who had high
levels of PA. Furthermore, the authors noted that a threshold for
achieving energy balance occurred at an activity level corre-
sponding to 7116 steps per day. Thus, it may be that increase in
sedentariness in the course of the years has allowed much
steeper trajectory in population weight gain than what would
have been otherwise.
Voluntary exercise is the most important discretionary com-
ponent of total daily energy expenditure, and thus has the poten-
tial to affect energy balance. This has been illustrated in a
number of longitudinal studies. For example, in a prospective
study with 20 years of follow-up, Hankinson et al.37 showed that
maintaining high level of PA mitigates weight gain significantly,
particularly in women. In that study, active individuals gained
less weight during the followed period compared with those
who were consistently inactive. Similar findings have been
reported from the Finnish Twin Cohort, which can be consid-
ered as a natural experimental approach to investigate the role
of PA and genes or other familial factors on future morbidity.38
Twins who have been consistently discordant LTPA for over 30
years differ significantly from each other in terms of body
weight and body composition; physically active co-twins have
significantly lower body weight,39 BMI,40 and fat percent, and
they have much less (50%) visceral and hepatic fat41 compared
with their inactive co-twin. This evidence clearly shows that
persistently higher PA level is associated with decreased rate of
weight gain even after controlling for genetic liability and
childhood environment. There is also a wealth of evidence from
controlled trials that exercise (or PA) carried out over long
periods of time can generate energy deficit and thereby induce
weight loss.42–44 Series of reviews,45,46 including a Cochrane
Review47 (which is considered as the golden standard in assess-
ing evidence), indicate that exercise induces weight loss, and
that the weight loss is even greater when coupled with energy
restriction. Thus, both diet and exercise are important compo-
nents in the programs intended for weight loss. However, the
majority of the weight loss programs seem to fail in the long-
term as people often regain weight.48 Consequently, a general
perception, particularly among the layman, is that only very few
succeed in long-term maintenance of weight loss. However,
153
long-term weight loss maintenance is a question of behavioral
adherence. Studies have clearly shown that continued adher-
ence to diet and exercise strategies are associated with long-
term success.49
5. Conclusion
The increase in obesity epidemic is occurring against the
background of continuous decline in the energy expenditure
required for daily living. However, the idea that obesity is
increasing because of consistent decline in daily energy expen-
diture is not supported either by objective measures of energy
expenditure or physiological theory of weight gain. Clearly,
obesity results from excessive energy intake that has sustained
over a long period of time. Currently, we do not understand why
people consume more energy than they expend. It may be that
PA has the ability to regulate food intake, but in the contempo-
rary environment that is conducive for sedentary behavior, this
regulatory mechanism has gone astray. Increasing PA most
certainly can create energy deficit through increased energy
expenditure. For this reason PA and exercise hold potential as
part of the solution for the ongoing obesity epidemic.
Competing interests
The author declares no competing financial interests.
References
1. Finkelstein EA, Khavjou OA, Thompson H, Trogdon JG, Pan L, Sherry B,
et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med
2012;42:563–70.
2. Lu Y, Hajifathalian K, Ezzati M, Woodward M, Rimm EB, Danaei G.
Metabolic mediators of the effects of body-mass index, overweight, and
obesity on coronary heart disease and stroke: a pooled analysis of 97
prospective cohorts with 1.8 million participants. Lancet 2014;383:970–83.
3. McGee DL. Body mass index and mortality: a meta-analysis based on
person-level data from twenty-six observational studies. Ann Epidemiol
2005;15:87–97.
4. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al.
Global, regional, and national prevalence of overweight and obesity in
children and adults during 1980–2013: a systematic analysis for the Global
Burden of Disease Study 2013. Lancet 2014;384:766–81.
5. Blair SN, Archer E, Hand GA. Commentary: Luke and Cooper are wrong:
physical activity has a crucial role in weight management and determinants
of obesity. Int J Epidemiol 2013;42:1836–8.
6. Hill JO, Peters JC. Commentary: physical activity and weight control. Int J
Epidemiol 2013;42:1840–2.
7. Luke A, Cooper RS. Physical activity does not influence obesity risk: time
to clarify the public health message. Int J Epidemiol 2013;42:1831–6.
8. Church TS, Thomas DM, Tudor-Locke C, Katzmarzyk PT, Earnest CP,
Rodarte RQ, et al. Trends over 5 decades in U.S. occupation-related
physical activity and their associations with obesity. PLoS One 2011;
6:e19657. doi: 10.1371/journal.pone.0019657
9. Fogelholm M, Mannisto S, Vartiainen E, Pietinen P. Determinants of
energy balance and overweight in Finland 1982 and 1992. Int J Obes Relat
Metab Disord 1996;20:1097–104.
10. Borodulin K, Harald K, Jousilahti P, Laatikainen T, Mannisto S, Vartiainen
E. Time trends in physical activity from 1982 to 2012 in Finland. Scand J
Med Sci Sports 2016;26:93–100.
11. Borodulin K, Vartiainen E, Peltonen M, Jousilahti P, Juolevi A,
Laatikainen T, et al. Forty-year trends in cardiovascular risk factors in
Finland. Eur J Public Health 2015;25:539–46.
12. Ng SW, Popkin BM. Time use and physical activity: a shift away from
movement across the globe. Obesity Rev 2012;13:659–80.
154
13. Prentice AM. The emerging epidemic of obesity in developing countries.
Int J Epidemiol 2006;35:93–9.
14. Archer E, Shook RP, Thomas DM, Church TS, Katzmarzyk PT, Hebert JR,
et al. 45-year trends in women’s use of time and household management
energy expenditure. PLoS One 2013;8:e56620. doi: 10.1371/journal.pone.
0056620
15. Lanningham-Foster L, Nysse LJ, Levine JA. Labor saved, calories lost: the
energetic impact of domestic labor-saving devices. Obes Res 2003;
11:1178–81.
16. Archer E, Lavie CJ, McDonald SM, Thomas DM, Hebert JR, Taverno Ross
SE, et al. Maternal inactivity: 45-year trends in mothers’ use of time. Mayo
Clin Proc 2013;88:1368–77.
17. McCormack GR, Virk JS. Driving towards obesity: a systematized
literature review on the association between motor vehicle travel time and
distance and weight status in adults. Prev Med 2014;66:49–55.
18. Rhodes RE, Mark RS, Temmel CP. Adult sedentary behavior: a systematic
review. Am J Prev Med 2012;42:e3–28.
19. Thorp AA, Owen N, Neuhaus M, Dunstan DW. Sedentary behaviors and
subsequent health outcomes in adults a systematic review of longitudinal
studies, 1996–2011. Am J Prev Med 2011;41:207–15.
20. Knuth AG, Hallal PC. Temporal trends in physical activity: a systematic
review. J Phys Act Health 2009;6:548–59.
21. Westerterp KR, Speakman JR. Physical activity energy expenditure has not
declined since the 1980s and matches energy expenditures of wild
mammals. Int J Obes (Lond) 2008;32:1256–63.
22. Dugas LR, Harders R, Merrill S, Ebersole K, Shoham DA, Rush EC, et al.
Energy expenditure in adults living in developing compared with
industrialized countries: a meta-analysis of doubly labeled water studies.
Am J Clin Nutr 2011;93:427–41.
23. Ravussin E, Burnand B, Schutz Y, Jequier E. Twenty-four-hour energy
expenditure and resting metabolic rate in obese, moderately obese, and
control subjects. Am J Clin Nutr 1982;35:566–73.
24. Leibel RL, Rosenbaum M, Hirsch J. Changes in energy expenditure
resulting from altered body weight. N Engl J Med 1995;332:621–
8.
25. Swinburn B, Sacks G, Ravussin E. Increased food energy supply is more
than sufficient to explain the US epidemic of obesity. Am J Clin Nutr
2009;90:1453–6.
26. Silventoinen K, Sans S, Tolonen H, Monterde D, Kuulasmaa K, Kesteloot
H, et al. Trends in obesity and energy supply in the WHO MONICA
Project. Int J Obes Relat Metab Disord 2004;28:710–8.
27. Balanza R, Garcia-Lorda P, Perez-Rodrigo C, Aranceta J, Bonet MB,
Salas-Salvado J. Trends in food availability determined by the Food and
Agriculture Organization’s food balance sheets in Mediterranean Europe
in comparison with other European areas. Public Health Nutr 2007;
10:168–76.
28. Archer E, Hand GA, Blair SN. Validity of U.S. nutritional surveillance:
National Health and Nutrition Examination Survey caloric energy intake
data, 1971–2010. PLoS One 2013;8:e76632. doi: 10.1371/journal.pone.
0076632
29. Black AE, Prentice AM, Goldberg GR, Jebb SA, Bingham SA,
Livingstone MB, et al. Measurements of total energy expenditure provide
insights into the validity of dietary measurements of energy intake. J Am
Diet Assoc 1993;93:572–9.
30. Black AE, Cole TJ. Biased over- or under-reporting is characteristic of
individuals whether over time or by different assessment methods. J Am
Diet Assoc 2001;101:70–80.
31. Levitsky DA, Pacanowski CR. Free will and the obesity epidemic. Public
Health Nutr 2012;15:126–41.
P. Wiklund
32. Vandevijvere S, Chow CC, Hall KD, Umali E, Swinburn BA. Increased
food energy supply as a major driver of the obesity epidemic: a global
analysis. Bull World Health Organ 2015;93:446–56.
33. Mayer J, Roy P, Mitra KP. Relation between caloric intake, body weight,
and physical work: studies in an industrial male population in West Bengal.
Am J Clin Nutr 1956;4:169–75.
34. Blundell JE, King NA. Physical activity and regulation of food intake:
current evidence. Med Sci Sports Exerc 1999;31(Suppl. 11):S573–83.
35. Hill JO, Wyatt HR, Peters JC. Energy balance and obesity. Circulation
2012;126:126–32.
36. Shook RP, Hand GA, Drenowatz C, Hebert JR, Paluch AE, Blundell JE,
et al. Low levels of physical activity are associated with dysregulation of
energy intake and fat mass gain over 1 year. Am J Clin Nutr 2015;
102:1332–8.
37. Hankinson AL, Daviglus ML, Bouchard C, Carnethon M, Lewis CE,
Schreiner PJ, et al. Maintaining a high physical activity level over 20 years
and weight gain. JAMA 2010;304:2603–10.
38. Leskinen T, Kujala UM. Health-related findings among twin pairs
discordant for leisure-time physical activity for 32 years: the
TWINACTIVE study synopsis. Twin Res Hum Genet 2015;18:266–72.
39. Waller K, Kaprio J, Kujala UM. Associations between long-term physical
activity, waist circumference and weight gain: a 30-year longitudinal twin
study. Int J Obes (Lond) 2008;32:353–61.
40. Piirtola M, Kaprio J, Waller K, Heikkila K, Koskenvuo M, Svedberg P,
et al. Leisure-time physical inactivity and association with body mass
index: a Finnish Twin Study with a 35-year follow-up. Int J Epidemiol
2016. doi: 10.1093/ije/dyw007 [Epub ahead of print].
41. Leskinen T, Sipila S, Alen M, Cheng S, Pietilainen KH, Usenius JP, et al.
Leisure-time physical activity and high-risk fat: a longitudinal
population-based twin study. Int J Obes (Lond) 2009;33:1211–8.
42. Donnelly JE, Honas JJ, Smith BK, Mayo MS, Gibson CA, Sullivan DK,
et al. Aerobic exercise alone results in clinically significant weight loss for
men and women: midwest exercise trial 2. Obesity (Silver Spring)
2013;21:E219–28.
43. Jakicic JM, Marcus BH, Lang W, Janney C. Effect of exercise on 24-month
weight loss maintenance in overweight women. Arch Intern Med
2008;168:1550–9. discussion 59–60.
44. Rosenkilde M, Auerbach P, Reichkendler MH, Ploug T, Stallknecht BM,
Sjodin A. Body fat loss and compensatory mechanisms in response to
different doses of aerobic exercise–a randomized controlled trial in
overweight sedentary males. Am J Physiol Regul Integr Comp Physiol
2012;303:R571–9.
45. Ballor DL, Keesey RE. A meta-analysis of the factors affecting
exercise-induced changes in body mass, fat mass and fat-free mass in males
and females. Int J Obes 1991;15:717–26.
46. Catenacci VA, Wyatt HR. The role of physical activity in producing and
maintaining weight loss. Nat Clin Pract Endocrinol Metab 2007;
3:518–29.
47. Shaw K, Gennat H, O’Rourke P, Del Mar C. Exercise for overweight or
obesity. Cochrane Database Syst Rev 2006;(4):CD003817. doi:
10.1002/14651858.CD003817.pub3
48. Elfhag K, Rossner S. Who succeeds in maintaining weight loss? A
conceptual review of factors associated with weight loss maintenance and
weight regain. Obesity Rev 2005;6:67–85.
49. Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr
2005;82(Suppl. 1):S222–5.
50. Trends in Global Obesity. Available at http://www.worldobesity.org/
resources/obesity-data-repository/resources/trends/12/; 2014 [accessed
23.03.2016].